Navigating Risk in Atrial Fibrillation and Hereditary Hemorrhagic Telangiectasia: Antithrombotic Versus Antifibrinolytic Therapy

Hereditary hemorrhagic telangiectasia (HHT) is characterized by mucocutaneous telangiectasias and arteriovenous malformations, often complicated by chronic epistaxis. Patients with HHT and comorbid atrial fibrillation (AF) present a clinical challenge in the concurrent management of bleeding and clotting risks. We retrospectively reviewed HHT patients with AF to evaluate the tolerability of anticoagulant (AC), antiplatelet (AP), and TXA therapies. Of 33 patients, AC was attempted in 13 cases, with 62% requiring premature discontinuation due to bleeding. AP therapy was initiated in 9 patients, with 33% discontinued due to epistaxis. Fourteen patients who met criteria for AC/AP were not prescribed them due to bleeding concerns. TXA was administered in 11 patients for a mean of 16.6 months with no thrombotic events; 6 were not prescribed TXA due to AF-related concerns. Our findings suggest that antithrombotic therapy for AF is frequently withheld or discontinued in this population, while TXA may be safely tolerated.